Officials at Ronald Reagan UCLA Medical Center continued outreach efforts as of February 20, to patients potentially affected by a “superbug” outbreak that has infected at least seven people, killing two. The hospital notified 179 patients who underwent endoscopic procedures between Oct. 3, 2014, and Jan. 28 that they may have been exposed. Seven patients have been infected with the bacteria, and two of them have died, hospital officials said.

Hospital officials insisted Thursday February 19, they followed all required procedures in handling the outbreak. They are even reaching out to patients who likely were not treated with a pair of medical scopes later found to be infected with the potentially deadly carbapenem-resistant Enterobac­teriaceae, or CRE, bacteria. The infections were traced to two of seven Olympus-manufactured duodenoscopes used by the hospital for the procedures, which are conducted to diagnose and treat diseases of the liver, bile ducts and pancreas.

The hospital is notifying all 179 of the patients, even though not all of them were treated with the two scopes that carried the bacteria.

“We’re being very cautions and we’re actually contacting all patients who underwent (endoscopic procedures) ... even if another scope was used on them,” said Dr. Zachary Rubin, the hospital’s director of infection prevention.

Dr. Robert Cherry, the hospital’s chief medical and quality officer, said a wider range of notification – including to patients not treated with the suspect scopes – was decided upon out of “an abundance of caution.”

“We’ve sent letters out, we’ve placed phone calls to each of those patients. We are offering free testing for those patients as well as any type of potential treatment options and discussions about those options,” he said.

The Food and Drug Admini­stration issued a warning to hospitals through its safety communications systems about duodenoscopes. It said the design of the scopes may make them more difficult to clean, and it urged that they be washed meticulously. UCLA officials said they had been following all the required steps for sterilizing the scopes, which are inserted through the throat and considered minimally invasive, but the infections still managed to spread.

The hospital has now switched to a more thorough cleaning system, involving a disinfection process at the hospital, then at an off-site process that uses ethylene oxide gas to sterilize the equipment. Potentially exposed patients at UCLA are being offered a home testing kit that will then be analyzed at the hospital. Hospital officials said similar exposures to CRE have been reported at other American hospitals that use the same type of scopes.

As soon as the infection was identified at UCLA, hospital officials said they notified the Los Angeles County Department of Public Health. Dr. Benjamin Schwartz, the department’s deputy chief of acute communicable disease control, hailed the work done by UCLA to identify the infection and reach out to patients.

He also stressed that the outbreak “is not a threat to the health of the public in L.A. County.” Officials at the U.S. Centers for Disease Control and Prevention said they are assisting the Los Angeles County Department of Public Health in its investigation of the UCLA infections. CRE is a family of bacteria that is resistant to many common antibiotics. The bacteria can cause infections in patients who have other serious medical problems or who are “undergoing operations or other invasive procedures,” hospital officials said.

Since 2012, there have been about a half-dozen outbreaks affecting up to 150 patients in Illinois, Pennsylvania and Washington State, the Los Angeles Times reported. Last month, Virginia Mason Medical Center in Seattle acknowledged that 32 patients were sickened by contaminated endoscopes from 2012 to 2014 with a bacterial strain similar to CRE. Eleven died. But, according to The Times, Virginia Mason said other factors may have contributed to their deaths because many of them were already critically ill.